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1 . SEWAGE <br /> Distance to Public Sewers /y Connection necessary: Yes No,Z <br /> Does existing septic system comply with Ord. #549 : Yes_, No <br /> Unknown If no, explain: <br /> Descr be se tic installation to 'be installed: ./-��� <br /> 2. WATER SUPPLY <br /> Is wa er supplied by private well : Yes 9L_ No Is well proper: <br /> Yes No State deficiency: <br /> Does existing or porposed use make this wellpublic Water: Yes <br /> No�. Sample of well water taken: Yes No� Date taken <br /> Results Additional information or comments— <br /> 3 . <br /> �il'd�ip0di�/�',�i/�.G�✓/io���'" r✓,��'E :i� �'E�'a.�-d I�.�✓-�rG*.i✓,'�./.G`f�•..� <br /> 3 . GARBAGE & REFUSF <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY. MOSGUT_TO OR Vr .j_02_ZCi'rENTTAL <br /> State possible vector potential necessary control: <br /> 5 . TOILET/BATH FACTLIT 3 <br /> No. ec location existing: Additional <br /> facilities needed - <br /> 6. PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SANT:E,8T10N <br /> State any problems not previously noted: 1:e'- <br /> 3 . POPULATTON DFNSTTY <br /> Appx. No . People per sq. m i . '�.C� �/.�� �i�E✓�r�E�-;T--'�.0 <br />